Provider Demographics
NPI:1275359952
Name:PINNACLE PEDIATRICS AND INTERNAL MEDICINE PROFESSIONAL LLC
Entity type:Organization
Organization Name:PINNACLE PEDIATRICS AND INTERNAL MEDICINE PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-223-6177
Mailing Address - Street 1:1776 CURTIS ST STE 130
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-2541
Mailing Address - Country:US
Mailing Address - Phone:720-239-7725
Mailing Address - Fax:720-239-7730
Practice Address - Street 1:1776 CURTIS ST STE 130
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-2541
Practice Address - Country:US
Practice Address - Phone:720-239-7725
Practice Address - Fax:720-239-7730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty